It has often been argued that if a clinician cannot decide which of two treatments to offer, a trial may be ethical, but it is unethical if she/he has a preference. Since individual clinicians usually have a preference, most trials could be judged unethical according to this line of argument. A recent important article in the New England Journal of Medicine argued that individual preferences are not as important as the collective uncertainty of informed clinicians. If clinicians are equally divided, (...) there is a state of collective equipoise and a trial is ethical. However, clinicians will seldom be exactly equally divided. We conducted an ethometric study to find out how much collective equipoise can be disturbed before the potential subjects in a trial think that it is unethical. Half of our subjects perceived a trial as unethical when equipoise was disturbed beyond 70:30. In other words, when 70 per cent of experts favour one treatment, 50 per cent of subjects would prefer that treatment to be administered rather than subjected to critical assessment. When equipoise is disturbed beyond 80:20, less than 3 per cent of subjects would consider human trials morally justifiable. (shrink)

Volume 1. The Anscombe-Lewis debate : from analogia entis to analogia fidei -- "God ... or a Bad, or Mad, Man" : C.S. Lewis's argument for Christ's divinity--a systematic theological, historical, and philosophical analysis of aut Deus aut malus homo -- Atonement : a unified model and event, the drama of redemption - understanding and rationalizing the tradition -- Scripture and the Christ, the Word of God : C.S. Lewis and Karl Barth--Convergence and Divergence -- The Pittenger-Lewis Debate : fundamentals (...) of an ontological Christology -- The question of multiple incarnations : imagination and paradox, reality and salvation. (shrink)

Software agents that play a role in E-commerce and E-government applications involving the Internet often contain information about the identity of their human user such as credit cards and bank accounts. This paper discusses whether this is necessary: whether human users and software agents are allowed to be anonymous under the relevant legal regimes and whether an adequate interaction and balance between law and anonymity can be realised from both the perspective of Computer Systems and the perspective of Law.

This paper explores difficulties around consent in the context of organ retention and return. It addresses the proposals of the Independent Review Group in Scotland on the Retention of Organs at Post Mortem to speak of authorisation rather than consent. Practical problems about whose consent determines disputes in relation to organ retention are explored. If a young child dies and his mother refuses consent but his father agrees what should ensue? Should the expressed wishes of a deceased adult override the (...) objections of surviving relatives? The paper suggests much broader understanding of the issues embedded in organ retention is needed to provide solutions which truly meet families' and society's needs. (shrink)

Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not (...) survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

The Human Tissue Act 2004 is designed to regulate the storage and use of organs and tissues from the living, and the removal, storage and use of the same material from the deceased. It repeals much criticized legislation, including the Human Tissue Act 1961, and establishes a Human Tissue Authority to ensure compliance with the Act via a licensing and monitoring regime. When the Act comes into force, probably in April 2006, it will be a criminal offence not to comply (...) with certain provisions of the Act, and a new offence of DNA 'theft' will be introduced. Importantly, the Act places consent at the centre of the system, both from the living and from or on behalf of the deceased. (shrink)

Things and Their Place in Theories Our talk of external things, our very notion of things, is just a conceptual apparatus that helps us to foresee and ...

Radical changes are taking place in the United Kingdom in relation to the classification of, and access to, medicines. More and more medicines are being made available over the counter both in local pharmacies and in supermarkets. The provision of more open access to medicines may be hailed as a triumph for patient autonomy. This paper examines whether such a claim is real or illusory. It explores the ethical and legal implications of deregulating medicines. Do patients benefit? What is the (...) impact on pharmacists? Are the true beneficiaries of change largely the pharmaceutical industries? (shrink)

Manchester's multi-disciplinary approach to medical ethics combines established methods and new initiatives. There is a longstanding Medical Group and also, plans are evolving for the inclusion of medical ethics teaching in the undergraduate curriculum, the start of an MA in Health Care Ethics in October 1987 and the establishment of the Centre for Social Ethics and Policy to act as a focus within the university for research and study in a wider context.

Explores the nature and types of mystical experience and discusses the value of mysticism for humanity.

W. V. Quine is one of the most eminent philosophers alive today. Now in his mid-eighties he has produced a sharp, sprightly book that encapsulates the whole of his philosophical enterprise, including his thinking on all the key components of his epistemological stance--especially the value of logic and mathematics. New readers of Quine may have to go slowly, fathoming for themselves the richness that past readers already know lies between these elegant lines. For the faithful there is much to ponder. (...) In this short book, based on lectures delivered in Spain in 1990, Quine begins by locating his work historically. He provides a lightning tour of the history of philosophy (particularly the history of epistemology), beginning with Plato and culminating in an appreciative sketch of Carnap's philosophical ambitions and achievements. This leads, in the second chapter, to an introduction to Quine's attempt to naturalize epistemology, which emphasizes his continuities with Carnap rather than the differences between them. The next chapters develop the naturalistic story of the development of science to take account of how our conceptual apparatus is enhanced so that we can view the world as containing re-identifiable objects. Having explained the role of observation sentences in providing a checkpoint for assessing scientific theories, and having despaired of constructing an empirical criterion to determine which sentences are meaningful, Quine in the remaining chapters takes up a variety of important issues about knowledge. He concludes with an extended treatment of his views about reference and meaning and his attitudes toward psychological and modal notions. The presentation is distinctive, and the many small refinements of detail and formulation will fascinate all who know Quine's philosophy. (shrink)

In the United Kingdom, the debate about how best to meet the shortfall of organs for transplantation has persisted on and off for many years. It is often presumed that the answer is simply to alter the law to a system of presumed consent. Acting perhaps on that presumption in his annual report launched in July, the Chief Medical Officer, Sir Liam Donaldson, advocated a system of organ donation based on presumed consent, the so-called “opt-out” system.1 He is calling for (...) a change in the law in England and Wales whereby consent to organ donation is presumed, making a person’s organs automatically available for transplantation after death, unless they registered objections to this while alive. Subsequently, the British Medical Association lent its support to the introduction of such a system.2 The BMA contends that “the practice of presumed consent legislation has had a significant effect on the number of cadaveric donors per million population.”2It is often taken for granted that there must be a correlation between the enactment of legislation on presumed consent and an increase in organ donation and procurement. However, the correlation is not as straightforward as it might seem. It may be that other practical measures to encourage organ donation could be implemented without changing the Human Tissue Act 2004, an Act which has been in force for barely a year.An analysis by Abadie and Gay demonstrated that “presumed consent legislation has a positive and sizeable effect on organ donation rates”,3 but they themselves admitted that the correlation between rates of donation and presumed consent legislation is “not completely unequivocal”.3 It is true that among the most successful cases in procurement rates are countries with presumed consent legislation . However, since some of the …. (shrink)

Through clear explanation of its characteristic concepts and doctrines, and paying close attention to the published works of its philosophers, the volume ...

Developing a simple test to identify swiftly neonates with sepsis who carry the genetic variant which means that one dose of the recommended antibiotic, gentamicin, will cause the child to become profoundly deaf looks like an admirable objective. The baby needs antibiotics and needs them within 1 hour of admission to the neonatal intensive care unit. Conventional genetic tests take much longer to yield results. The test being trialled produces results in 25 min; a baby who carries the variant can (...) be treated with a different antibiotic. All the test requires is a gentle swab of the baby’s inner cheek. Babies can be treated for potentially fatal sepsis without the risk that the drugs designed to save their lives will cost them their hearing. Parents and healthcare staff are relieved of worry—a great idea? PALOH is not a trial of the safety or efficacy of the test, only to assess how feasible it will be to carry out this test in a busy NICU, without disrupting the care of the baby. A tiny painless ‘scrape’ will take a sample of DNA—what’s the fuss about? Several other invasive and painful procedures will be carried out without a fuss.1 The problem is DNA. Genetic information must be safeguarded from falling into the wrong hands. In section 45 of Human Tissue Act 2004, Parliament legislated to prohibit non-consensual DNA testing.1 It fits uncomfortably in a statute designed to regulate retention and uses of human material, after revelations that organs and tissue from the …. (shrink)

We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)

Formulated by Aquinas, commented on by post-Copernican philosophers and theologians, analysed in depth by C.S. Lewis, and deliberated by some contemporary writers, the question of multiple incarnations either within humanity or amongst extra-terrestrial sentient species is all too intermittently examined: ‘Can the Christ be incarnated more than once in our reality, or somewhere else in the universe, or another reality?’ In this paper, we examine the debate and the conclusions: that is, Lewis’s position within his philosophical theology and his analogical (...) narratives; also, some contemporary philosophers of religion and theologians (Karl Rahner, with Christopher L. Fisher and David Fergusson; Sjoerd L. Bonting and William B. Drees; E.L. Mascall and Brian Hebblethwaite; Oliver Crisp and Keith Ward). How do they relate to Aquinas’s handling of the question and how do they compare with Lewis’s approach based on a theology of the imagination (grounded in Augustine and Alice Meynell)? Can Lewis resolve the argument? Could alien species have witnessed wholly different acts, equally unique, costly to God, and necessary to the process of salvation? Any answer or explanation relates to the function and purpose of the incarnation: the Fall, original sin—therefore, how we define the boundaries, limits, of atonement. (shrink)

"A potent source of inspiration for anyone interested in the therapeutic potential of Buddhism. David Brazier writes with clarity and authority about the Zen way."—Mark Epstein, M.D. author of Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective. "Comprehensive and readable... should appeal to anyone broadly interested in Buddhism."—Helen Sieroda psychosynthesis psychotherapist. In this book, psychotherapist David Brazier offers readers in the West a fresh perspective on Buddhist psychology and demonstrates how Zen Buddhist techniques are integrated into psychotherapy. (...) Writing from the viewpoint of a Western psychotherapist, Dr. Brazier successfully demystifies Buddhist psychology, explains the conceptual foundations of Buddhist thought, and with the help of vivid case studies, clearly demonstrates how a Buddhist approach can provide a practical path to personal growth. (shrink)

Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the ``unethical'' experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical (...) research. (shrink)

Why should we respect the wishes which individuals may have about how their body is treated after death? Reflecting on how and why the law respects the bodies of the living, we argue that we must also respect the ‘dead’. We contest the relevance of the argument ‘the dead have no interests’, rather we think that the pertinent argument is ‘the living have interests in what happens to their dead bodies’. And, we advance arguments why we should also respect the (...) wishes of the relatives of the deceased regarding what happens to the bodies of their loved ones. In our analysis, we use objections to organ and tissue donation for conscientious reasons (often presented as religious reasons) to show why the living can have interests in their dead bodies, and those of their dead relatives, and why these interests should be respected. (shrink)

Can a corporation have a conscience? What is wrong with reverse discrimination? Can ethical management and managed care coexist? Hoffman, Frederick, and Schwartz address these and many other current, intriguing, often complex issues in corporate morality. This introductory business ethics text contains a thorough general introduction on ethical theory, 54 readings, and 25 cases. Divided into five parts, each with an introduction that presents the major themes of its articles and cases, the text contains an impartial, point-counterpoint presentation of different (...) perspectives on the most important issues being debated in business ethics. Each chapter ends with questions that can be used for student discussion, review, tests/quizzes, or for student assignments. The fourth edition has 27 new readings, 15 new cases, and 10 new mini-cases. (shrink)

When Gautama Buddha first set forth the principles of what came to be known as Buddhism, it was, above all, in an effort to help people achieve freedom from mental suffering. In the twenty-five hundred years since the death of the "Great Physician", his disciples have continued to expand upon his teachings and to develop sophisticated psychotherapeutic methodologies. Yet, only recently has Western medicine begun to take its first tentative steps toward recognizing and embracing the therapeutic potential of Buddhism. In (...) a book that will do much to advance the fusion of two great psychotherapeutic traditions, psychotherapist David Brazier offers mental health practitioners in the West a fresh perspective on Buddhist psychology and demonstrates how Zen Buddhist techniques can be integrated successfully into their clinical practices. Writing from the perspective of a Western psychotherapist, Dr. Brazier successfully demystifies Buddhist psychology for fellow practitioners. He carefully explains the conceptual foundations of Buddhist thought, and with the help of numerous case studies, he clearly demonstrates their clinical applications. (shrink)

Throughout most of human history women have been defined by their biological role in reproduction, seen first and foremost as gestators, which has led to the reproductive system being subjected to outside interference. The womb was perceived as dangerous and an object which husbands, doctors and the state had a legitimate interest in controlling. In this article, we consider how notions of conflict surrounding the womb have endured over time. We demonstrate how concerns seemingly generated by the invisibility of reproduction (...) and the inaccessibility of the womb have translated into similar arguments for controlling women, as technology increases the accessibility of the female body and the womb. Developments in reproductive medicine, from in vitro fertilisation to surrogacy, have enabled women and men who would otherwise have been childless to become parents. Uterus transplants and ‘artificial wombs’ could provide additional alternatives to natural gestation. An era of ‘womb technology’ dawns. Some argue that such technology providing an alternative to ‘natural’ gestation could be a source of liberation for female persons because reproduction will no longer be something necessarily confined to the female body. ‘Womb technology’, however, also has the potential to exacerbate the labelling of the female body as a source of danger and an ‘imperfect’ site of gestation, thus replaying rudimentary and regressive arguments about controlling female behaviour. We argue that pernicious narratives about control, conflict and the womb must be addressed in the face of these technological developments. (shrink)

A Brief History of Time: From the Big Bang to Black Holes is a popular-science book on cosmology (the study of the origin and evolution of the universe) by British physicist Stephen Hawking. It was first published in 1988. Hawking wrote the book for readers who have no prior knowledge of the universe and people who are interested in learning.

While the idea of philosophy as conceptual analysis has attracted many adherents and undergone a number of variations, in general it suffers from an authority problem with two dimensions. First, it is unclear why the analysis of a concept should have objective authority: why explicating what we mean should express how things are. Second, conceptual analysis seems to lack intersubjective authority: why philosophical analysis should apply to more than a parochial group of individuals. I argue that Hegel’s conception of social (...) ontology, focused on his concept of “ethical life” (Sittlichkeit), helps to explain how concepts (and their explication) have both objective and intersubjective authority in the social domain. Hegel claims that modern institutions are the product of self-conscious purposes, so that they are conceptually constituted. Concepts do not just represent these objects and so depend on a contingent relation to them. As many contemporary social ontologists agree, this means that our concepts of these institutions are uniquely epistemically “transparent.” They have objective authority. Concepts have intersubjective authority in the modern world as well, according to Hegel. However, I show that this feature of Hegel’s account does not rely on the solution to a philosophical problem. Rather, since the concepts of modern ethical life are “essentially contested,” their content depends on the practical and political agreement of modern subjects. This means that concepts can only have objective authority if some prior intersubjective agreement has been reached. The role of philosophy as conceptual analysis is thus importantly dependent on political developments. (shrink)

Witnessing in merging biological, social and algorithmic realities is crucial to trust, as modelled in the YUTPA framework. Being witness and bearing witness is fundamental to human interaction. System participation in human communities of practice challenges the notion of witnessing and therefore the ability to build trust. Nevertheless, through trial and error, people in a variety of practices have found ways to establish the presence and develop trust in merging realities. This paper presents the results of 20 in-depth interviews with (...) professionals from a variety of disciplines and nations. The conclusion of cumulative analysis is that systems do not witness themselves, but their output deeply affects the mental maps that human beings make of each other, the world around them and their own self. Essential qualities human beings seek when being involved with other beings are defined by granularity and reciprocity in the design of time (duration of engagement, synchronizing performance, integrating rhythms and moments to signify), place (body sense, material interaction, emotional space and situated agency), relation (shared meaning, engagement, reputation and use) and action (tuning, reciprocity, negotiation and quality of deeds). By designing granular interaction in 4 dimensions, reciprocity in witnessing obtains significance and the basis for establishing trust in a variety of presences emerges while human agency acquires potential. (shrink)

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. Discussions refer (...) both to specific groups and specific issues. (shrink)

P. KOnig: Einleitung - P. ZIche: Idiographik und allgemeine Wissenschaftlichkeit - Windelband und die Wissenschaftsreflexion um 1900 - G. HArtung: Ein Philosoph korrigiert sich selbst - Wilhelm Windelbands Abkehr vom Relativismus - O. SChlaudt: Philosophie am Leitfaden der Empirie. WIndelbands relativistisches Programm - S. KUft: Windelbands Konzeption von Transzendentalphilosophie und ihr Bezug zur Kulturphilosophie - R. BOnito Oliva: Windelband. KUlturphilosophie und Kulturkrise - P. KOnig: Teleologie und Geschichte bei Wilhelm Windelband - J. BOhr: Im Fortschreiben der Probleme: Windelbands 19. JAhrhundert (...) - T.-H. CHang: Der Wertbegriff beiWilhelm Windelband und sein Konzept der Problemgeschichte - T. KUbalica: Die Geschichte der Philosophie als Problemgeschichte - J. MEhlich: Windelbands Praludien und das Silberne Zeitalter in Russland - G. SChluter: Windelbands italienische Kontakte und Bezugnahmen - D. STefanelli: Notizen uber Karl Vossler und die "Sudwestdeutsche Schule" - C. ZAnfi: Geschichte, Natur und Leben: Windelband und Bergson in der Historismus-Debatte - J.-I. LIndén: Der beseelte Geist: Dilthey als Kritiker der badischen Schule - H. GUndlach: Windelbands Ringen mit der Psychologie - Anhang: Wilhelm Windelband: Blaue Hefte zur Psychologie. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Protecting the Vulnerable explores the reality of patient control and choice in health care and analyzes how decisions should be made on behalf of those deemed incapable of making decisions. The contributors, distinguished experts from the disciplines of medicine, ethics, theology, and law, look at the complex problem of autonomy and consent in health care and clinical research today from an illuminating perspective--its impact on the vulnerable members of society. The essays move from the exploration of lingering paternalism in health (...) care to the acute dilemma of treatment of and research on newborn babies. In covering both general and specific problems the collection reveals how exploitation can occur when the right of autonomy is eroded and where informed consent is illusory. Particularly vulnerable groups, such as children and people with mental handicaps, are discussed alongside cases where the vulnerability is itself an issue. Other areas covered include: `gesture' suicides, the practical problems of doctors in dealing with dependent patients, and the limits of proxy consent. All health care professionals, ethicists, policy makers, and lawyers currently engaged in the study or practice of health care ethics will find Protecting the Vulnerable to be a vital source of information for many years to come. (shrink)

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. Discussions refer (...) both to specific groups and specific issues. (shrink)

In the Transcendental Aesthetic (TA), Kant is typically held to make negative assertations about “things in themselves,” namely that they are not spatial or temporal. These negative assertions stand behind the “neglected alternative” problem for Kant’s transcendental idealism. According to this problem, Kant may be entitled to assert that spatio-temporality is a subjective element of our cognition, but he cannot rule out that it may also be a feature of the objective world. In this paper, I show in a new (...) way how Kant’s view (focusing on his conclusions about space) is not subject to this objection, by showing that he does not make the denial about mind-independent reality that he is typically held to make. The argument develops consequences of a new reading of Kant’s expression “an sich selbst” (‘in itself’; ‘in themselves’). I argue that “an sich selbst” or “per se” has a special, judgment-level role, so that this expression does not form new noun-terms adjectivally. It follows that the conceptual unit of Kant’s “Conclusions” in the TA is simply “things” (Dinge), since “things in themselves” is not a nominal expression; Kant adopts the Wolffian ontological use of “thing” as the basic kind-term for any existent. The arguments that things per se are not in space are arguments that space cannot be a necessary property or relations of things as a kind. I show that this does not involve the positive claim about mind-independent reality that inspires the neglected alternative objection. (shrink)

If within the borders of human life the truth is, as Vico has said, what is made, then the task of a student of human life can be and should be to find out from what human beings have made what manner of makers they are and what sorts of production their circumstance allows.